Exploring Job Stress Among Public Health Workforce in Northeastern Malaysia.

Introduction Job stress is recognized as a significant concern across various occupational settings which have profound implications for both individuals and organizations. During the COVID-19 pandemic, job stress among the public health workforce (PHW) has been a significant concern, as they face a significantly increased risk of infection and mortality due to excessive COVID-19 exposure. This study presents a descriptive exploration of key job stress-related factors among PHW in Terengganu, Malaysia. Methodology This is a cross-sectional study conducted from May 2022 to April 2023, encompassing all eight District Health Offices (DHO) and government health clinics in Terengganu. Data collection involved a Malay version of the Job Content Questionnaire (M-JCQ), which assesses job characteristics based on Karasek's demand-control-support model and consists of four main domains: decision latitude, psychological job demands, physical job demands, and social support. Data was collected from 1044 participants, and statistical analysis was performed using SPSS version 27 (IBM Corp., Armonk, NY, USA). Findings Of the 1044 participants, 18.9% experienced job stress. The highest percentage of job stress was observed among nurses (24.3%), followed by medical assistants (18.3%) and physicians (16.0%). In contrast, the public health assistant (PKA) group had the lowest rate of job stress. Job types based on Karasek's model also showed variations, with doctors having the highest percentage of active jobs (46.4%), while medical assistants had the highest percentage of low job strain (17.9%), and PKAs had the highest percentage of passive job types (44.7%). Conclusion This study offers significant insights into the work-related challenges faced by the public health workforce in Terengganu, Malaysia, especially during the COVID-19 pandemic. Job stress is a substantial concern, and understanding its underlying factors is essential for improving the well-being of PHWs. Decision latitude, job demands, and social support play critical roles in shaping job stress among PHWs. Strategies and interventions are needed to mitigate job stress, improve working conditions, and enhance the effectiveness of PHWs in public health initiatives. This study highlights the importance of addressing job stress in this sector, with potential benefits for both the mental and physical health of PHW.

Translation and Validation of the Risk Perception on Safety and Health Questionnaire Among Palm Oil Plantation Workers in Terengganu, Malaysia.

INTRODUCTION: Occupational safety and health are of utmost importance in the palm oil industry, particularly in Malaysia where palm oil plantation workers face various hazards. This study aimed to translate and validate a risk perception questionnaire specifically designed to assess the perceptions of safety and health risks among palm oil plantation workers in Terengganu, Malaysia. METHODOLOGY: The original risk perception questionnaire, consisting of 22 items, was translated into the local language and culturally adapted. The translation process involved forward translation, expert panel discussions, and back translation to ensure linguistic equivalence. The translated questionnaire was then administered to a sample of palm oil plantation workers in Terengganu, Malaysia, for validation purposes. Confirmatory factor analysis (CFA) was conducted to assess the model fitness of the questionnaire, and Cronbach's Alpha coefficient was calculated to determine the internal consistency reliability of the final model. RESULTS: The translated risk perception questionnaire demonstrated good model fitness as indicated by CFA results (X2=224, df=79, p-value<0.0001, root mean square error of approximation (RMSEA)=0.07, goodness of fit index (GFI)=0.929, comparative fit index (CFI)=0.902). The questionnaire's final version has one factor comprising 13 items, selected based on factor loadings and theoretical relevance. The internal consistency reliability of the 13-item questionnaire was satisfactory, with a Cronbach's Alpha coefficient of α=0.77. CONCLUSION: The 13-item risk perception questionnaire demonstrated a good model fit and acceptable internal consistency reliability. It shows that the questionnaire is a valid and reliable tool to evaluate the level of risk perception on safety and health among palm oil plantation workers in Malaysia.

Prevalence and Risk Factors of Low Back Pain in Malaysia: A Scoping Review.

Data on the prevalence and risk factors of low back pain (LBP) in Malaysia remain unclear as they are currently limited to specific settings and occupational groups. Therefore, this study aims to determine the prevalence and risk factors of low back pain in Malaysia. In this scoping review, we had systematically searched PubMed, Scopus, ScienceDirect and Google Scholar from January 2016 to April 2020. In addition, we had included cross-sectional studies on LBP in Malaysia. Studies without data on the prevalence and risk factors were excluded. The settings, population, design, sample size, evaluation methods, prevalence and risk factors of the studies were summarised. The literature search identified 435 potentially eligible studies; of these, 21 had met the inclusion criteria. The prevalence of LBP in Malaysia among various types of the population had ranged from 12.4% to 84.6%. Among the various types of occupation, the prevalence of LBP was the highest among nurses (67.9%), followed by drivers (65.7%). In addition, age, gender, body mass index (BMI), lifting heavy objects, working posture, lifestyle, working hours and mental health were identified as the risk factors of LBP in Malaysia. The current evidence suggests that LBP is a serious health problem among several occupational groups in Malaysia. Therefore, it is crucial to implement the correct interventions for the prevention of LBP among these groups.

An Association Between Job Stress and Poor Social Support Among Healthcare Workers in Northeastern Malaysia.

INTRODUCTION: Job stress is an important occupational health problem globally. Hence, identification of workers at risk of developing job stress is paramount to the decision-makers. This study aims to estimate the proportion of job stress and its relationship with different categories of healthcare workers (HCWs) in the primary care and public health settings in northeastern Malaysia. METHODOLOGY: A cross-sectional study involving 520 HCWs across all categories was conducted in Kelantan State, Malaysia. A proforma and validated Malay version of the Job Content Questionnaires were administered to obtain the data. The participants were then classified into four categories of workers according to Karasek's job demands-control model classification which were active, passive, high strain, and low strain. RESULTS: We found that a total of 145 (28.5%) HCWs in the study have job stress (high-strain job type). HCWs with a degree or higher qualification had the highest proportion of job stress (41.2%), while the diploma group has the lowest proportion of job stress among the four academic qualification groups (22.9%). Pearson chi-square shows a significant association between Karasek's job types and the level of social support from their supervisors (p < 0.05) but no association between job strain and the level of supervisor's social support (p > 0.05). CONCLUSION: Job stress among HCWs is prevalent, and the professional group had the highest percentage of risk job stress as compared to other groups. There is a significant association between the supervisor's social support and Karasek's job strain categories.

Knowledge of the Malaysian National Immunisation Programme and its associated factors among parents in Dungun, Terengganu: A cross-sectional study.

Introduction: The number of unvaccinated children and the rate of vaccination refusal among parents have recently increased despite the robust vaccination programme in Malaysia. The purpose of this study was to determine the level of knowledge of the Malaysian National Immunisation Programme among Malaysian parents as well as the variables that contribute to poor knowledge. Method: Methods: This study used systematic random sampling to recruit 375 parents from seven health clinics in the Dungun District of Malaysia. The participants were asked to complete a selfadministered validated questionnaire that included sociodemographic and knowledge questions. A multiple logistic regression analysis was applied to determine the associated factors of poor knowledge of immunisation. P-values of <0.05 were considered statistically significant. Results: A total of 189 (50.4%) respondents had poor knowledge of immunisation. The multiple logistic regression analyses revealed that a low educational level (adjusted odds ratio (OR): 1.92; 95% CI 1.25-2.95) was associated with poor knowledge while the age-group of 30-40 years old (adjusted OR: 0.56; 95% CI 0.34-0.93) was protected against it as compared to the age-group of <30 years old. Conclusion: The prevalence of poor knowledge of immunisation among parents in Dungun, Terengganu, is relatively high. The focus of health promotion and education must be switched to increasing immunisation knowledge among the public, particularly among high-risk groups.

Comparison of the Modified Barthel Index (MBI) Score Trends Among Workers With Stroke Receiving Robotic and Conventional Rehabilitation Therapy.

INTRODUCTION:  Stroke is one of the top causes of adult-acquired disabilities and the fifth most prominent cause of death worldwide. Working-age populations contribute about 40% of the stroke cases which occur annually in Malaysia. The modified Barthel Index (MBI) score has been used for self-care assessment to determine if stroke patients can meet their fundamental needs. The study was designed to compare the trend of MBI scores of workers who had a stroke and underwent robotic rehabilitation therapy to those who had conventional therapy. METHODOLOGY:  A cohort study was conducted among workers who had a stroke in northeastern Malaysia. They were assigned either to undergo robotic or conventional rehabilitation therapy. The robotic therapy is performed three times per day for four weeks. Meanwhile, conventional therapy involved walking exercises five days per week for two weeks. Data were collected for both therapies on the admission, at week 2 and week 4. The MBI, modified Rankin Scale (mRS) and Hospital Anxiety and Depression Scale (HADS) trends were examined one month after the therapies. The R (version 4.2.1) (R Core Team, Vienna, Austria) and RStudio (R Studio PBC, Boston, USA) were applied to perform the descriptive analyses on the respective platforms. Repeated measures of analysis of variance were performed to evaluate the outcomes trend and the effectiveness of the two therapies was also compared. RESULTS: A total of 54 stroke patients participated in this study of which 30 (55.6%) of them received robotic therapy. The age of the subjects ranged from 24 to 59 years and the majority (74.1%) were male. Stroke outcomes were evaluated using mRS, HADS, and MBI scores. Except for their age, the individuals' characteristics did not significantly differ between those undergoing conventional therapy and those receiving robotic therapy. After four weeks, it was found that the good mRS had increased, whereas the poor mRS had decreased. Comparing the therapy groups, the MBI scores improved significantly with time, although there were no significant differences between the therapy groups. However, the interaction term between the treatment group (p=0.031) and improvements over time was significant (p=0.001), indicating that robotic was more effective than conventional therapy in improving the MBI scores. For HADS score, there was a significant difference between the therapy groups (p=0.001), with those receiving robotic therapy having higher HADS score. CONCLUSION:  Functional recovery occurs in acute stroke patients when the mean Barthel Index score rises from the baseline (on admission) to week 2 (during therapy) and subsequently on discharge (week 4). Based on these findings, it appears that there was not one therapy superior to the other; nevertheless, robotic therapy may be better tolerated and more effective in certain individuals.

Job Dissatisfaction and Its Predictors among Healthcare Workers of 'Type 2 Health Clinics' in North-Eastern Malaysia.

It is crucial to comprehend factors associated to job dissatisfaction among healthcare workers (HCWs) in Malaysia's primary health clinics, especially those working in 'Type 2 Health Clinics' which cater for populations of >50,000 and a daily average number of patients between 500 and 800. It is essential to ensure that effective strategies can be proposed to promote job satisfaction. A total of 314 HCWs from 'Type 2 Health Clinics' in north-eastern Malaysia consented to participate in this cross-sectional study, conducted between October 2020 and December 2021. The Job Satisfaction Survey was used to assess job dissatisfaction. The prevalence of job dissatisfaction was 35.7%. The significant factors associated with job dissatisfaction were younger age and those who were dissatisfied with their yearly performance mark. Targeted interventional activities for young HCWs and for those who are dissatisfied with their yearly performance mark are recommended to improve job satisfaction.

Assessment of Knowledge, Attitude, and Practice on Safe Working in Confined Space among Male Water Services Workers in the Central Region of Malaysia.

Employee performance in terms of knowledge of job scope, safe working practices, and safety-related attitude at work are used to measure an organization's success in managing employee welfare and safety to prevent workplace injury and death. This study aims to determine the level of knowledge, attitude, and practice on safe working in confined space among water services workers. A cross-sectional study involving a randomly selected 207 water services workers working in a confined space was performed in the central region of Malaysia. The assessment was performed using a validated Malay self-administered questionnaire. Descriptive statistics, Chi-square test and Logistic regression were used for data analyses. The study's participants were all men, with a mean (SD) age of 35.2 (8.83) years. The average working duration was 10.8 years. Overall, 67.1% of participants had good knowledge, while 65.7% had a positive attitude. The majority of the workers (60.4%) were found to follow safe working practices. Regression analysis revealed that significant predictors for knowledge were age [Adjusted odds ratio (Adj. OR) 2.793; 95% CI: 1.310, 5.955; p = 0.008] and attitude (Adj. OR 2.127; 95% CI: 1.011, 4.526; p = 0.048). Attitude was influenced by marital status (Adj. OR 4.126; 95% CI: 2.079, 8.186; p < 0.001) and knowledge level (Adj. OR 2.224; 95% CI: 1.025, 4.824; p = 0.043). A positive attitude was the sole predictor influencing the safe practice (Adj. OR; 1.878; 95% CI: 1.041, 3.388; p = 0.036). In conclusion, the workers' levels of knowledge, attitudes, and practices were relatively satisfactory. Extensive investment in workplace safety and health programs, appropriate training, growth opportunities, and effective employee performance evaluation methodologies may assist workers in performing at their best.

Risk Factors Associated with Defaulted Follow-Up and Sharp Injury Management among Health Care Workers in a Teaching Hospital in Northeastern Malaysia.

Sharp injury is a serious occupational risk for healthcare workers (HCWs). This study aimed to determine the distribution and associated factors of sharp injury cases among HCWs working at a teaching hospital in northeastern Malaysia. This was a retrospective cohort study on all reported sharp injury cases from 2015 to 2020. The secondary data were examined using descriptive and multiple logistic regression. Statistical significance was determined for associated factors of HCWs who did not attend immediate treatment after a sharp injury or any of the subsequent follow-up variables, with a p-value of less than 0.05. A total of 286 cases fulfilled the study criteria. The mean (SD) age of sharp injury was 29.4 (5.38) years. The overall defaulted rate for follow-up was 51.4%. Multiple logistic regression revealed a significant relationship between defaulted follow up on sharp injury management and job category as well as the type of device used. Being a doctor (Adj OR 2.37; 95% CI: 1.40, 4.03; p = 0.010) and those using other sharp instruments such as Coupland and drip sets (Adj OR 4.55; 95% CI: 1.59, 13.02; p = 0.005) had a higher odds to default follow up on sharp injury management. In conclusion, although there is a link between defaulting the follow-up and both the work category and the type of device that caused the injury, a deeper analysis is needed to uncover any additional factors and determine the appropriate intervention strategies to ensure follow up adherence.

Patient Safety Culture and Its Associated Factors: A Situational Analysis among Nurses in Katsina Public Hospitals, Northwest Nigeria.

BACKGROUND: Patient safety involves identifying, assessing, and managing patient-related risks and occurrences to improve patient care and reduce patient harm. In Nigeria, there is a lack of studies on patient safety culture, especially in the northern part of the country. This study aimed to determine the levels and factors that contribute to nurses' negative perceptions of patient safety culture in public health facilities. METHODOLOGY: A total of 460 nurses were surveyed across 21 secondary health facilities using the Hospital Survey on Patient Safety Culture, and the response rate was 93.5%. Descriptive statistics and multiple logistic regression were used to analyze the data. RESULTS: The results showed that 59.8% of the respondents were female, and 42.6% were within the age range of 30-39 years old. Most of them (48.3%) had spent 1-5 years working in the hospital. Three out of 12 composite measures had higher negative responses (staffing-30.5%, non-punitive response to error-42.8%, and frequency of events reported-43.1%). A multiple logistic regression analysis affirmed that all three variables, in addition to organizational learning, were significant associated with overall negative perceptions of patient safety culture, with 3.15, 1.84, 2.26, and 2.39 odds ratios, respectively. CONCLUSION: The results revealed that four critical areas of patient safety required improvement; therefore, intervention is recommended to minimize unnecessary patient harm and medical expenses.

Development and Validation of Knowledge, Attitude, and Practice Questionnaire: Toward Safe Working in Confined Spaces.

Confined space workers do a wide range of tasks, many of which have a significant risk of hazardous exposure. Hence, a reliable and valid questionnaire is important in assessing the knowledge, attitude, and practice (KAP) of workers in this field. The present study was conducted to develop and validate a questionnaire that could assess the KAP for safe working in a confined space. The questionnaire went through a development and validation process. The development stage consisted of a literature review, expert's opinion, and evaluation by experts in the field via cognitive debriefing. The validation stage encompassed exploratory and confirmatory parts to investigate the psychometric properties of the questionnaire. A total of 350 participants were recruited among confined space workers from two oil and gas companies in Malaysia. The two-parameter logistic item response theory (2-PL IRT) analysis was used for the knowledge section. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used in the attitude and practice sections of the validation stage. The development stage resulted in 30 items for knowledge, attitude, and practice sections. Items in the knowledge section showed an acceptable difficulty and discrimination, as noted during the 2-PL IRT analysis. The EFA resulted in a one-factor model for attitude and practice sections, and contained 18 items, with factor loading > 0.4. The Cronbach's alpha was 0.804 and 0.917 for attitude and practice sections, respectively. The CFA for attitude and practice sections indicated a good model fitness (Raykov's rho = 0.814 and 0.912, respectively). All items indicated good reliability and valid psychometrics for determining KAP on safe working in a confined space.

Inappropriate Doses of Intravenous Polymyxin B after Renal Adjustment Lead to Treatment Failure

Sub-therapeutic doses, shorter duration of therapy, female gender, bacteremia, and renal impairment were among independent predictors of polymyxin B treatment failure. In this study, we found an association between inappropriate doses of polymyxin B (<15000 or >25000 unit/kg/day) and renal impairment. Inappropriate doses of polymyxin B were significantly associated with CrCl 20-50 mL/min (p = 0.021, ORadj 6.660, 95% CI 1.326, 33.453) and CrCl <20 mL/min (p = 0.001, ORadj 22.200, 95% CI 3.481, 141.592). By conducting sub-group analysis only using subjects with appropriate dosage, renal impairment was not associated with polymyxin B treatment failure, thus indicating that treatment failure was due to an inappropriate dose of polymyxin B, rather than renal impairment. In conclusion, renal impairment was not directly associated with treatment failure but was due to an inappropriate dosage of polymyxin B after renal adjustment

Perceived Severity and Susceptibility towards Leptospirosis Infection in Malaysia.

BACKGROUND: Perceived severity and susceptibility refers to one's belief of the seriousness and the risk of contracting a specific disease. It is an essential study in public health as it assists in the understanding of the motivating factors towards disease prevention. This qualitative study aimed to explore perceived severity and susceptibility towards leptospirosis infection among respondents in two states of Malaysia. METHODS: Focus group discussions using the phenomenology approach was conducted involving 72 respondents in Selangor and Kelantan. Data were examined using content analysis. RESULTS: Respondents perceived leptospirosis infection as severe due to its poor disease prognosis and complications. However, some rated it less severe when compared with other chronic diseases such as cancer and AIDS. Their perceptions were influenced by their knowledge about the disease, media portrayal and frequency of health campaigns by the government. All respondents believed they were not susceptible to the disease. CONCLUSION: The low perceived susceptibility of leptospirosis infection is a matter of concern as it may contribute to respondents' lack of motivation towards preventing the disease. The study findings may provide the basis for health promotional activities designed to heighten public perceived threat towards leptospirosis infection and thereby improving preventive health behaviors for avoiding leptospirosis.

Interactive Low Back Pain Intervention Module Based on the Back School Program: A Cluster-Randomized Experimental Study Evaluating Its Effectiveness among Nurses in Public Hospitals.

The prevalence of low back pain (LBP) among nurses is high. The main aim of this study was to evaluate the effectiveness of an interactive LBP module based on the Back School Program in improving Oswestry Disability Scores (ODSs) among nurses in government hospitals in Penang, Malaysia. A cluster-randomized experimental study was conducted within four public hospitals. These hospitals were randomized to intervention and control groups. A total of 284 nurses from the selected hospitals were randomly selected (142 in each group). An interactive LBP intervention module based on the Back School Program was designed and prescribed. Both the intervention and control groups were assessed using the Oswestry Disability Questionnaire at baseline and at the end of the third and sixth weeks. Out of 284 participants, 281 completed this study. A between-group comparison revealed that ODSs were significantly lower in the intervention group than in the control group at the ends of the third (p = 0.006) and sixth weeks (p < 0.001). Within-group changes revealed a significant reduction in ODSs within the intervention group from baseline to the third (p < 0.001) and sixth weeks (p < 0.001) of the intervention. This simple interactive LBP module was effective in reducing symptoms of LBP among nurses as early as three weeks, and this effect was sustained until the sixth week of the intervention.

Psychometric Properties of the Decisional Balance Scale: A Confirmatory Study on Malaysian University Students.

Decisional balance (DB) is the perceived positive aspects (advantages) and negative aspects (disadvantages) that are associated with behavioural change. Behavioural change is dependent on an individual's thoughts after considering the advantages of engaging in exercise. When the benefits exceed the barriers, people are more likely to make changes after cognitively evaluating the functional aspects. The purpose of the present study is to determine the validity and reliability of the DB scale among Malaysian university students using a confirmatory factor analysis (CFA). A cross-sectional study was carried out among students who took part in the co-curricular program. By using the purposive sampling method, students were recruited and given written informed consent forms after acknowledging they understood the purpose of the study. The DB scale, which consists of two factors, namely, advantages and disadvantages, was used as the instrument in the study. The advantages referred to the benefits of participating in exercise, whereas the disadvantages referred to the barriers to exercise. The 10-item, self-administered questionnaires were distributed to participating students. Data were analysed using Mplus 8 for the CFA. A total of 562 students (females = 444, males = 118) with a mean age of 19.81 years (SD = 1.22) participated in the study. Most of the students were engaged in regular physical activity for at least three exercise sessions (mean = 2.62) per week, and the average duration per session was 43 minutes. The hypothesised measurement model of DB did not fit the data well; thus, the measurement model was re-specified. The final measurement model fit the data well (comparative fit index (CFI) = 0.960, Tucker-Lewis index (TLI) = 0.943, standardised root mean square residual (SRMR) = 0.055, root mean square error of approximation (RMSEA) (90% confidence interval (CI)) = 0.061 (0.047, 0.074), RMSEA p-value = 0.096). The composite reliability values of 0.757 for the advantages and 0.792 for the disadvantages were acceptable. The 10-item DB scale with two factors displayed a good model fit for the data with good scale reliability. This could be beneficial for Malaysian undergraduate students in making decisions before engaging in physical activity. The benefits of, and barriers to, exercise could be an important component that affects their decision making.

Low Back Pain and Its Associated Factors among Nurses in Public Hospitals of Penang, Malaysia.

OBJECTIVES: To determine the prevalence of low back pain (LBP) and its associated factors among the nurses working in the public hospitals of Penang, Malaysia. METHODS: A cross-sectional study was conducted on nurses, aged 25-60 years, who had been working for at least three months at six public hospitals of Penang. A proportionate stratified random sampling method was applied to select 1292 respondents. The Malay-validated BACKS Tool questionnaire using a 5-point Likert scale was used to obtain data. Simple and multiple logistic regression analyses were performed. RESULTS: A total of 989 (76.5%) nurses suffered from LBP at a point of time. The factors significantly associated with LBP among the nurses included working more than seven hours [adjusted odds ratio (AOR) (95% confidence interval (CI)) 1.48 (1.06, 1.98)], twisting of the body while working [AOR (95% CI) 1.60 (1.13, 2.26)], manual handling of patients in wards [AOR (95% CI) 1.44 (1.08, 2.07)], and fatigue [AOR (95% CI) 2.63 (1.94, 3.58)]. CONCLUSION: The prevalence of LBP among the nurses in the public hospitals of Penang was relatively high. The factors predicting LBP included working more than seven hours a day, twisting of the body while working, manual handling, and fatigue. The findings from this study may better enable policymakers to devote resources to minimize low back pain among nurses. The nurses should be encouraged to comply with safe working procedures.

Leptospirosis and its prevention: knowledge, attitude and practice of urban community in Selangor, Malaysia.

BACKGROUND: Leptospirosis is still endemic in Malaysia and has been prevalent in Selangor where cases have been underreported. Primarily, this was due to lack of awareness in the urban community in this region. This study determined the knowledge, attitude and preventive practice (KAP) of leptospirosis, and identified the significant predictors influencing KAP among urban community in Hulu Langat, Selangor. METHODS: This cross-sectional study was conducted from 2015 to 2017 using validated questionnaire. Sampling methods included multistage cluster sampling, followed by simple random sampling to obtain 315 respondents. Descriptive analysis was performed to determine the KAP while χ2 and the subsequent logistic regression analysis were carried out to identify associations and predictors between variables. RESULTS: Respondents were mainly Malaysian Bumiputra with a mean (Standard Deviation (SD)) age of 32.5 (13.0) years. Of 315 respondents, 80.3% (n = 253) had poor knowledge, 87.0% (n = 274) had good attitude, and 81.3% (n = 256) showed unacceptable practice towards leptospirosis and its prevention. Regression analysis identified age as the sole predictor influencing good knowledge (AOR 2.388; 95% CI = 1.298, 4.396; p = 0.005). Education level (AOR 2.197; 95% CI = 1.109, 4.352; p = 0.024) was also noted as the significant predictor influencing the overall practice. CONCLUSIONS: The urban community in Selangor showed a positive attitude in waste management despite having little knowledge regarding the disease itself. The study also discovered inadequacy in preventive practice, hence marking the importance of the proper integration of knowledge and attitude into forming an acceptable practice to reduce transmission of Leptospira among urban population in Malaysia.

Trends in stroke outcomes at hospital discharge in first-ever stroke patients: Observations from the Malaysia National Stroke Registry (2009-2017).

BACKGROUND: Stroke outcomes could be a quality indicator across the continuum of care and inform stroke management policymaking. However, this topic has rarely to date been studied directly. AIMS: We sought to investigate recent trends in stroke outcomes at hospital discharge among first-ever stroke patients. METHODS: This was an analysis of data from the Malaysia National Stroke Registry. Patients aged 18 years or older documented as having a first episode of stroke in the registry were recruited. Subsequently, the comparison of proportions for overall and sex-specific stroke outcomes between years (from 2009 to 2017) was conducted. The primary outcome was modified Rankin Scale score, which was assessed at hospital discharge, and each patient was categorized as follows: 1) functional independence, 2) functional dependence, or 3) death for analysis. RESULTS: This study included 9361 first-ever stroke patients. Approximately 36.2% (3369) were discharged in an independence state, 53.1% (4945) experienced functional dependence, and 10.8% (1006) patients died at the time of hospital discharge. The percentage of patients who were discharged independently increased from 23.3% in 2009 to 46.5% in 2017, while that of patients discharged in a disabled state fell from 56.0% in 2009 to 45.6% in 2017. The percentage of death at discharge was reduced from 20.7% in 2009 to 7.8% in 2017. These findings suggest that the proportions of stroke outcomes at hospital discharge have changed significantly over time (p < 0.001), and there was a significant sex-related difference in stroke outcomes at hospital discharge following first stroke episode (p < 0.001). CONCLUSIONS: Our data indicate there has been a significant change in stroke outcomes over the past nine years in Malaysia. This information ought to be considered in ongoing efforts of tertiary stroke prevention.

Reply to Comments on the Study "The Sensitivity, Specificity and Accuracy of Warning Signs in Predicting Severe Dengue, the Severe Dengue Prevalence and its Associated Factors".

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Co-Curricular Activities and Motives for Participating in Physical Activity among Health Sciences Students at Universiti Sains Malaysia, Malaysia.

BACKGROUND: The purpose of the study was to compare the motives for participating in physical activity (PA) through the different types of co-curricular activities chosen by health sciences undergraduate students at Universiti Sains Malaysia (USM), Malaysia. METHODS: The participants were university students at USM's Health Campus, who were invited to volunteer and complete two measures: a demographic form, including the types of co-curricular activities in which the students chose to enrol (sports, uniform and art), and the Physical Activity and Leisure Motivation Scale (PALMS). RESULTS: A total of 588 university students (female = 79.1%, male = 20.9%) with a mean age of 19.77 (SD = 1.39) participated in the study. The results showed significant differences in the motives of affiliation (P < 0.001), appearance (P = 0.008) and physical condition (P = 0.010) across the types of co-curricular activities in which the students participated. The students who enrolled in sports generally showed higher motives of affiliation, appearance and physical condition for participating in PA than other types of co-curricular activities. CONCLUSION: The study findings can provide further insights into the motives for participating in PA among health sciences students and encouragement for students to integrate PA into their daily routines.